NPI | 1295363570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 025784) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14937) |
363A00000X Physician Assistant (Licence: NY 25784) | |
Enumeration Date | 2020-03-31 |
Last Update Date | 2025-09-16 |